Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.98 / $123.29 / $256.83	Facility	26	$86.98	$123.29	$256.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $289.45 / $354.51 / $1,477.00	Professional		$289.45	$354.51	$1,477.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.18 / $97.48 / $317.79	Professional	26	$79.18	$97.48	$317.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.32 / $260.57 / $574.78	Professional	TC	$213.32	$260.57	$574.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $205.20 / $235.04 / $308.11	Professional		$205.20	$235.04	$308.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.95 / $103.88 / $145.60	Professional	26	$66.95	$103.88	$145.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $195.15 / $219.15 / $326.57	Professional	TC	$195.15	$219.15	$326.57
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $100.43 / $117.84 / $1,023.17	Professional	26	$100.43	$117.84	$1,023.17
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $296.64 / $483.32 / $688.63	Professional		$296.64	$483.32	$688.63
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $86.55 / $140.22 / $184.31	Professional	26	$86.55	$140.22	$184.31
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $210.09 / $338.48 / $504.29	Professional	TC	$210.09	$338.48	$504.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $249.49 / $399.06 / $657.89	Professional		$249.49	$399.06	$657.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.04 / $105.64 / $173.84	Professional	26	$63.04	$105.64	$173.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.44 / $292.97 / $474.58	Professional	TC	$186.44	$292.97	$474.58
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $358.46 / $461.04 / $731.18	Professional		$358.46	$461.04	$731.18
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $94.89 / $118.18 / $179.30	Professional	26	$94.89	$118.18	$179.30
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.37 / $313.13 / $446.09	Professional	TC	$251.37	$313.13	$446.09
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.19 / $384.68 / $424.30	Professional		$331.19	$384.68	$424.30
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.00 / $105.22 / $151.05	Professional	26	$95.00	$105.22	$151.05
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $254.69 / $331.10 / $397.32	Professional	TC	$254.69	$331.10	$397.32
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $311.79 / $311.79 / $311.79	Professional		$311.79	$311.79	$311.79
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $86.57 / $116.67 / $1,023.17	Professional	26	$86.57	$116.67	$1,023.17
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $82.84 / $118.46 / $256.83	Facility	26	$82.84	$118.46	$256.83
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $294.42 / $375.74 / $1,407.00	Professional		$294.42	$375.74	$1,407.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $81.01 / $99.40 / $283.99	Professional	26	$81.01	$99.40	$283.99
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $217.90 / $272.62 / $654.52	Professional	TC	$217.90	$272.62	$654.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $98.80 / $310.43 / $503.58	Professional		$98.80	$310.43	$503.58
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $252.99 / $400.00 / $659.98	Professional		$252.99	$400.00	$659.98
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.04 / $105.15 / $176.46	Professional	26	$63.04	$105.15	$176.46
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.44 / $291.14 / $474.58	Professional	TC	$186.44	$291.14	$474.58
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $85.61 / $85.61 / $90.24	Facility	26	$85.61	$85.61	$90.24
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $300.26 / $305.01 / $397.11	Professional		$300.26	$305.01	$397.11
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $83.40 / $85.67 / $90.24	Professional	26	$83.40	$85.67	$90.24
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $214.58 / $219.40 / $306.87	Professional	TC	$214.58	$219.40	$306.87
United Facility/Professional Professional Modifier Low / Median / High Price $284.10 / $363.81 / $610.28	Professional		$284.10	$363.81	$610.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.33 / $104.75 / $174.68	Professional	26	$82.33	$104.75	$174.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $201.48 / $257.94 / $446.24	Professional	TC	$201.48	$257.94	$446.24